Wachter: strategic investment in clinical leaders is vital

The Wachter Review of NHS IT has said significant new investment in developing chief clinical information officers is vital to the success of NHS digitisation.

The report from US ‘digital doctor’ Robert Wachter, which was published overnight, recommends that £42 million should be devoted to developing a new cadre of CCIOs, informatician clinicians, and other IT leaders.

This is equivalent to 1% of the £4.2 billion of investment in NHS IT over the next five years that was agreed with the Treasury in the last spending review and announced by health secretary Jeremy Hunt earlier this year.

Creating a national CCIO role

‘Making IT Work: Harnessing the power of Health Information technology to Improve Care in England’ sets out ten recommendations, of which three focus on the need to develop and strengthen CCIOs.

The first of these is that a national CCIO should be appointed. “We believe that a national CCIO should be identified to oversee and coordinate NHS clinical digitisation efforts,” the report says, adding: “the new national CCIO should also “report directly to the Secretary of State for Health or the NHS England chief executive”.

The report says that the national CCIO role has both symbolic and strategic importance, since: “We could not find anyone who has ever cared for patients among those who have overall strategic responsibility for health IT in the NHS.”

This aspect of the report has already been acted on, with the appointment of Professor Keith McNeil, the former chief executive of Cambridge University Hospitals NHS Foundation Trust earlier this year.

However, the report advocates that the national CCIO role should be modelled on the US National Coordinator for Health IT, created in 2004 and held since exclusively by clinical-informatician leaders.

Building up a new cadre of clinical IT leaders

The greatest attention in the Wachter review is given to the need for a series of steps to be taken to develop a cadre of trained CCIOs for trusts and a broader workforce of clinician-informaticians.

It says this is essential if the NHS is to succeed in what Wachter terms the uniquely complex, long-term adaptive change of digitising healthcare.

“The advisory group was struck by the small number of leaders at most trusts who are trained in both clinical care and informatics, and their limited budgetary authority and organisational clout,” it says.

“This deficit, along with a general lack of workforce capacity amongst both clinician and non-clinician informatics professionals, needs to be remedied if trusts are to succeed in implementing and optimising health IT systems.

“There must be major effort to place well-qualified clinicians with advanced informatics training in every trust.

"For a large trust, there must be senior clinician-informatician (CCIO) reporting at the level of the board or the CEO, whose primary job (>75% time) is to lead and manage the purchase, implementation, and evolution of the clinical information system. 

“The advisory group estimates that an average-sized trust needs at least five such individuals on staff.  Their leader, the CCIO, should be a well-trained and credentialed clinician-informatician, and should report directly to the CEO.”

A new, National Digital Academy

To achieve this, the report notes, there will need to be a massive increase in the number of CCIOs and more formalised training for them.

Ahead of health secretary Jeremy Hunt’s appearance at the Health and Social Care Innovation Expo in Manchester this afternoon, NHS England announced that it would be setting up an NHS Digital Academy to train “budding digital leaders” in key skills.

The academy will train both chief information officers and CCIOs. In a statement, McNeil said: “The Digital Academy will run tailored training programmes in informatics and executive/change management, with both national and international partners to nurture ‘up and coming’ informaticians.”

McNeil said this would “ensure that clinical need is at the heart of every digital NHS project.”

Hunt is due to announce a raft of measures to accelerate NHS digitisation efforts at the Expo, including 12 digital ‘exemplar’ trusts and new patient-facing services. The creation of exemplars, and more national funding for them, were further recommendations in the Wachter review.

The report says the presence of a CCIO and supporting team, or plans to appoint and develop such a team, should be a key consideration in whether central investment is made in digitisation efforts particular trusts.

More status, more support for CCIOs

The review also highlights detailed survey results from the CCIO Network, hosted by Digital Health, showing how few funded clinical sessions most current CCIOs have, and the limited budgetary and management clout most have in their respective organisations.  

It says this needs to change, with “satisfying and sustainable CCIO positions in trusts” created. The “development of vibrant professional societies” is also advocated.

Overall, the report is keen to make sure that the lessons of digitisation efforts in the US, and through the National Programme for IT in the NHS, are learned, and that trusts not only make better IT deployments, but get the value out of them.

It says: “The dearth of professional, well-supported CCIOS with appropriate authority and resources is an enormous obstacle to successful deployment and benefits realisation of health IT at the trust level”.

It concludes that significant financial and professional investment is needed to address this.